tbuckley/cabot-search huggingface dataset:
Abstract 13236: Equitable Policy Lever? : State Minimum Wage Increases and Black - White Disparities in Hypertension
Authors: Brittany L Brown-Podgorski
Journal: Circulation (2022)

Introduction: Non-Hispanic Black adults are disproportionately burdened by hypertension compared to White adults. Because Black adults are overrepresented in lower-wage occupations - and lower income is associated with elevated risk of hypertension - minimum wage increases have been explored as a potential policy lever to address Black-White disparities in hypertension. States have the authority to increase minimum wages for workers in their jurisdiction; and 31 states have exercised this authority. However, research suggests that minimum wage increases may have no significant impact on health among Black adults due to “diminished gain” of health effects from socioeconomic resources. This study examines whether Black-White disparities in hypertension persist after states increase minimum wage limits. Methods: This study merged state-year minimum wage data from the US Department of Labor with pooled cross-sectional survey data from the Behavioral Risk Factor Surveillance System to assess the relationship between state-level minimum wage increases and Black-White disparities in hypertension over time (2001 - 2019). Separate difference-in-difference models were estimated to individually compare the odds of hypertension among Black and White adults in states with and without minimum wage increases. A difference-in-difference-in-difference model estimated whether minimum wage increases had a differential impact on the odds of hypertension among Black adults compared to White adults. Results: Compared to Black and White adults in states without minimum wage increases, both Black (OR= 0.86; p-value=0.04) and White (OR= 0.86; p-value=0.02) adults had a significantly lower odds of hypertension following state increases in the minimum wage. However, the Black-White disparity in hypertension significantly increased following minimum wage increases (OR= 1.50; p-value&lt;0.001). Conclusions: These findings suggest that minimum wage increases may benefit White adults significantly more than Black adults, resulting in an increased Black-White disparity in hypertension. As such, increasing minimum wage alone may not be an equitable policy approach to address this disparity.
Abstract 13444: Acute Anemia With Mechanical Circulatory Support; Unmasking the Culprit
Authors: Omofolarin Babayale, Swati Chand, Syed Faiz Abbas, Oluwaseun E Fashanu, Suman Biswas, Vishal Parikh
Journal: Circulation (2022)

Introduction: Mechanical circulatory support (MCS) is known to potentiate hemolytic anemia. Nevertheless, patients are also at an increased risk of spontaneous bleeding due to anticoagulation or post-procedural complication. We present two cases of acute anemia due to spontaneous retroperitoneal bleeding following insertion of the Impella assist device. Case Presentation: Two male patients aged 65 and 74 presented with cardiogenic shock secondary to ischemic cardiomyopathy with a low ejection fraction of 10% and 15%). Both patients initially had an intra-aortic balloon pump (IABP) inserted. Because of progressively deteriorating hemodynamics, IABP was switched to the Impella 5.5 device through the axillary artery. Following insertion of the Impella, they developed anemia requiring multiple blood transfusions. Despite repositioning of Impella, hemoglobin continued to drop prompting further workup. CT abdomen/pelvis revealed left retroperitoneal hematoma. CT angiogram showed active bleeding from the left L3 lumbar artery in one patient and multiple foci of active arterial extravasation in the other patient. Coil embolization was performed, achieving hemostasis and stabilization of hemoglobin levels in both patients. Discussion: Hemolytic anemia associated with the use of the Impella that improves with repositioning or device removal is well known and documented. However, patients with MCS are also at increased risk of spontaneous bleeding due to procedural injury and the use of anticoagulation. We report 2 cases with retroperitoneal bleeding from the lumbar artery diagnosed a few days after the placement of Impella. The occurrence of retroperitoneal hemorrhage was possibly spontaneous due to anticoagulation along with Impella-induced hemolysis resulting in acute anemia. Neither patient had any vascular access through the left groin making post-procedural complications less likely. The concealed nature and non-specific symptoms of retroperitoneal bleed can lead to a delay in diagnosis. Early identification and control of bleeding can prevent fatal outcomes. Conclusion: Our cases highlight the importance of clinicians having a broad differential and low threshold to investigate other causes of anemia in patients with MCS.
Abstract 13393: Equity Model Evaluation of a Predictive Cardiac Positron-Emission Tomography (PET) Risk Score for 90-Day and One-Year Major Adverse Cardiac Events and Revascularization
Authors: Raymond O McCubrey, Steve M Mason, Viet T Le, Daniel L Bride, Benjamin D Horne, Kent G Meredith, Nishant K Sekaran, Jeffrey L Anderson, Kirk U Knowlton, David B Min, Stacey Knight
Journal: Circulation (2022)

Introduction: Artificial Intelligence (AI) algorithms should be evaluated to discern differences in prediction amongst population groups. The Intermountain data science group has developed a software package iEAI, which performs a model evaluation (ME) analysis to detect such meaningful prediction differences. Here we apply this software package to a recently developed cardiac PET/CT stress test-based risk score that predicts 90-day and one-year major adverse cardiac events (including death and myocardial infarction) and revascularization (MACE-Revasc). The results of these analyses will reveal any discrepancies in prediction and help with equity. Methods: 5049 patients who had a clinically indicated PET/CT study from January 1, 2018, to December 31, 2018, were considered. The ME analyses were done for gender, age, and race. Precision (or positive predictive value) and recall (or sensitivity) were measured and meaningful differences were those that were statistically significant and had a ratio &lt; 0.85 or &gt;1.25 in magnitude than the reference category (e.g., the largest category). Results: The ME analysis of the PET/CT risk score for MACE-Revasc are shown in the table. For the 90-day PET/CT risk score a recall bias existed for females compared to males (0.49 vs 0.62). There was also bias with improved recall for Native-Hawaiian/ Pacific Islanders compared to Whites (0.87 vs 0.58). For the one-year PET/CT risk score, recall (0.38 vs 0.52) and precision (0.34 vs 0.47) biases were found for females compared to males, and recall biases were found for those aged 50-59 compared to 60-69 (0.34 vs 0.50). Conclusion: Meaningful biases were found in both the PET/CT risk scores for 90-day and One-year MACE-Revasc. As the application of AI in healthcare grows, evaluations like the above should be carried out. Then any detected inequalities could be addressed by refining or redeveloping the risk score models to eliminate biases.
Abstract 13603: Racial and Socioeconomic Differences Among Children With Kawasaki Disease in the South
Authors: Luz A Padilla, Kathryn Maxwell, Adriana H Tremoulet, Yung R Lau, Sadeep Shrestha
Journal: Circulation (2022)

Introduction: Kawasaki Disease (KD) is a leading cause of pediatric acquired heart disease in the U.S. Children of Black race seem to have more vulnerability to developing KD and face worse clinical outcomes. It is unknown if this is due to socio-economic disadvantages faced by this minority group or by host factors. The objective of this study is to identify racial and socio-economic differences among Black children with KD compared to other races. Methods: EMR (2000-2019) ICD codes served to identify KD children admitted to a single tertiary Southeast U.S. center. Subjects diagnosed and treated according to American Heart Association criteria were included. Socio-economic status was defined using a validated neighborhood deprivation index associated with the child’s ZIP-code at the time of KD hospitalization. Data was stratified and compared by deprivation status and race. Results: A total of 525 subjects (32% non-deprived White, 17.5% deprived White, 18.7% non-deprived Black, 31.8% deprived Black) were included. Deprived White children with KD had the highest proportion of intravenous immune globulin (IVIG) response (86.1%) compared to deprived Black children with the lowest (75.3%; p 0.02). Deprived Black children presented with KD at an earlier median age than any other group (26 vs ~40 months; p 0.008). Conclusions: This study suggests that factors like race and socio-economic status may affect KD age at presentation and outcomes among Black children with KD. Future studies that explore the attributable proportion from different factors that drive the disparate outcomes among Black children with KD are needed.
Abstract 13330: Cardiorespiratory Fitness is Associated With Decreased Platelet Reactivity
Authors: Joseph Grech, Bongani Nkambule, Florian Thibord, Melissa Chan, Ming-Huei Chen, Vasan S Ramachandran, Matthew G Nayor, Gregory Lewis, Andrew Johnson
Journal: Circulation (2022)

Introduction: Platelets are key mediators in atherosclerotic cardiovascular disease (CVD). Low cardiorespiratory fitness (CRF) is a major risk factor for atherosclerosis. However, little is known about the effects of CRF on platelet function. Methods: Platelet assays and cardiopulmonary exercise testing were conducted in the Framingham Heart Study (n= 3001). A linear mixed effects model was used to analyze associations between CRF (assessed by peak oxygen uptake [VO 2 ] in participants achieving a respiratory exchange ratio &gt;= 1), and platelet reactivity traits from multiple platelet function assays: whole blood Multiplate impedance aggregometry (MP), Total-Thrombus Formation Analysis System (T-TAS), and light transmission aggregometry (LTA). Statistical models adjusted for relatedness, age, sex, and anti-platelet medications. Bonferroni correction for multiple statistical testing resulted in a significance threshold of p&lt;7.35E-04. Results: Of 68 platelet traits analyzed, 31 traits passed the significance threshold, all with a direction of effect indicating higher CRF associated with decreased platelet reactivity. Significant traits spanned multiple platelet agonists. Our strongest associations were seen with MP after TRAP-6 (velocity, p=1.57E-26; AUC, p=2.33E-21; aggregation, p=5.30E-16) and ADP stimulation (velocity, p=1.63E-19; AUC, p=7.64E-17; aggregation, p=1.00E-11), and LTA after ristocetin stimulation (max aggregation, p=5.33E-11; AUC, p=1.11E-10). Conclusion: Our research adds to past work that shows CRF to be associated with reduced CVD by suggesting that decreased platelet reactivity may be involved mechanistically. We found significant associations with multiple platelet agonists, indicating higher CRF globally inhibits platelets; however, given the multiple strong associations after TRAP-6 and ADP stimulation, PAR-1 and purinergic signaling, respectively, may be most heavily involved. This is notable since each of these receptor pathways is directly or indirectly tied to anti-coagulant or anti-platelet therapies. Ultimately, our results suggest that CRF may be important for additional consideration in tailoring anti-platelet strategies.
Abstract 13706: Late Presentation Right Ventricular Failure in Patients With Left Ventricular Assist Device
Authors: Andrew G Navarro, Antonio Olivas-Martinez, Lorenzo Braghieri, Song Li, Claudius Mahr, Rong Tian, Kevin D O'Brien, Claudio A Bravo
Journal: Circulation (2022)

Introduction: Right Ventricular Failure (RVF) is an incompletely characterized complication seen in patients following durable left ventricular assist device (LVAD) implantation. Previous research focused on early post-implantation RVF, and its definitions are inconsistent. This study aims to characterize the incidence and clinical features of late presentation RVF in LVAD patients. Methods: This retrospective cohort study included all subjects who underwent LVAD implantation at the University of Washington between 2005 and 2021 and were on support for at least 90 days. Late RVF was defined as meeting Mechanical Circulatory Support Academic Research Consortium criteria and late RVF onset &gt;30 days post-implantation. The outcomes of interest were late RVF incidence and mortality while on LVAD support. Using Cox regression models, baseline factors were assessed as potential predictors for late RFV, with the time-varying exposure of developing late RVF after LVAD implantation as a risk factor for death. Results: The cohort included 430 LVAD recipients, median age 56 years (IQR 43-64), 17% women and 75% Caucasian. A total of 115 subjects met criteria for late RVF with a median time to RVF of 48 months (95% CI 43-63) and an incidence rate of 18.3 events per 100 person-years. Multivariable analysis showed that albumin, destination therapy (DT) LVAD, use of inotropes longer than 2 weeks post LVAD implantation, and device type were associated with development of late RVF. DT as treatment intention was the predictor with the highest hazard ratio (HR= 2.82, 95% CI 1.75-4.55, p&lt;0.001). After controlling for several covariates, RVF was associated with an increased hazard of death (HR 1.87, 95% CI 1.22 - 2.86, p = 0.004) (Figure). Conclusions: Late RVF while on LVAD support was a relatively common complication in this cohort and was associated with significantly higher mortality. LVAD implantation as DT was the predictor most strongly associated with late RVF.
Abstract 13811: A Percentile Approach to Refining ECG Criteria for Screening Female Athletes for Cardiac Risk
Authors: Chelsea S Harris, Vic F Froelicher, Matthew T Wheeler
Journal: Circulation (2022)

Introduction: Despite known differences in electrocardiographic (ECG) findings by sex, only empirical thresholds for both sexes exist in current ECG guidelines for screening athletes for risk of sudden cardiac death (SCD). We hypothesize that our large dataset - with diversity in age, race, and sport participation - can be utilized to improve ECG screening in female athletes. Methods: Computerized 12-lead ECGs were recorded and analyzed in female athletes who underwent PPE between 06/2010 and 09/2021. The 2017 international criteria for ECG interpretation were compared to either the 99th percentile in our cohort or the percentile that corresponded to the known disease prevalence for HCM and Long QT syndrome. For ST depression the 99.5th percentile, a marker for HCM, was used; for QTc prolongation, the 99.9th percentile was used. RS wave amplitude was considered a marker for hypertrophy or low voltage. Results: Of 3476 athletes, the 2017 international criteria classified 2.2% with at least one ECG abnormality requiring cardiological evaluation. Rates were similar across ages, race/ethnicity, and sporting discipline. Using a percentile approach based on our population, 3.3% would require additional workup. Surprisingly, ST depression up to 0.03 mV was a normal finding in this cohort. If RS voltage extremes were considered abnormal findings, an additional 9.6% of the population would be flagged using current definitions. This number decreases to 3.4% if using the 99th percentile. Conclusions: These results highlight a difference in the reported prevalence of ECG abnormalities when comparing empirically derived thresholds to statistically derived ranges that fall outside the 99th percentile. Consideration of new metrics specific to the female athlete population has the potential to further refine athlete ECG screening.
Abstract 13767: A Novel Pharmacological Inhibitor of Type 5 Adenylyl Cyclase Inhibitor Enhances Exercise Capacity and Protects Against Glucose Intolerance and Myocardial Ischemia
Authors: Jie Zhang, Dorothy E Vatner, Marko Oydanich, Vincent A Smeraglia, Jacques Roberge, Stephen F Vatner
Journal: Circulation (2022)

Disruption of adenylyl cyclase 5 (AC5 KO) is a healthful longevity model; not only do the AC5 KO mice live a third longer than wild type (WT) mice, but are also protected against heart failure, obesity and diabetes and exercise intolerance. To translate to the clinics, we developed a new drug, C90, which inhibits AC5, and examined its effects on cardioprotection in pigs, exercise capacity and glucose tolerance in mice. C90 (30 mg/kg/day) or vehicle were chronically administered to age-matched C57/BL6 male mice via osmotic pump. After baseline exercise, the WT mice, all performing similarly, were divided into two groups; one that received C90 for 14 days and the other receiving vehicle for 14 days. After 14 days of C90 treatment, WT mice exhibited greater exercise capacity reflected by longer running distance (384 ± 27 m vs. 253 ± 16 m, p&lt;0.05) and greater work to exhaustion (18.1 ± 1.5 J vs. 12.4 ± 0.7 J, p&lt;0.05) than mice receiving vehicle. Sensitivity to glucose was measured using a glucose tolerance test in mice. Following 14-days treatment with C90 (30 mg/kg/day), the mice exhibited an overall improvement in glucose tolerance, measured as area under the curve (A.U.) for glucose levels following insulin injection, when compared to vehicle (6414 ± 890 A.U. vs. 9658 ± 1039 A.U., p&lt;0.04). Furthermore, C90-treated mice had a lower fasting glucose level on a regular diet, when compared to vehicle (113 ± 6.5 mg/dl vs. 129 ± 4.2 mg/dl, p&lt;0.05). The cardioprotective effects of C90 were previously demonstrated in mice. In the current study, we investigated the cardioprotective effects of C90 in a porcine model of ischemia/reperfusion (I/R). Ischemia was induced for 60 min coronary artery occlusion, followed by 3-hours reperfusion. C90 (1.2 mg/kg), infused 5 min following the start of the reperfusion led to a decreased infarct size/area at risk (INF/AAR) (21.6 ± 4.3% vs. 36.8 ± 2.9%, p&lt;0.05) when compared to vehicle, with no difference between AAR/left ventricle between the C90 and vehicle groups. In view of its lower level of toxicity than other AC5 inhibitors, C90 is an excellent candidate for clinical development for pharmacological treatment of myocardial ischemia, glucose intolerance and exercise intolerance.
Abstract 13362: Increased Bleeding and Poor Outcomes in Patients Who Require Cardiac Procedures While Receiving P2Y12 Inhibitors
Authors: Charles V Pollack, Jeffrey Erickson, Jonathan Birchall, John Lee, Jeffrey R Skaar, Tyler Piazza, Rachel Liu, Kamran Mammadov
Journal: Circulation (2022)

Introduction: P2Y12 inhibitors (P2Y12i) reduce thrombotic risk in patients with acute coronary syndrome and in secondary prevention of atherothrombotic events, but dual antiplatelet therapy with a P2Y12i + aspirin increases bleeding risk. P2Y12i washout is recommended prior to procedures, but when procedures cannot be deferred, washout is precluded, thereby increasing periprocedural bleeding risk, with potential negative outcomes. Hypothesis: P2Y12i are associated with increased bleeding risk and poorer clinical and economic outcomes in invasive cardiovascular (CV) procedures. Methods: In a retrospective study of hospital chargemaster data (2017-2019), patients receiving P2Y12i (cangrelor, clopidogrel, prasugrel, ticagrelor, or ticlopidine) or aspirin without P2Y12i (control) prior to an invasive CV procedure were identified from hospital charge and ICD-10 codes. Inpatient bleeding, mortality, length of stay (LOS; days), and intensive care unit (ICU) LOS (days) were assessed. Results: Among 2,996,051 patients with invasive CT procedures, P2Y12i-treated patients had significantly higher bleeding rates versus control patients (4.2% vs 3.1% p&lt;0.05). Coronary artery bypass graft (CABG) procedures were the most common. Heart valve procedures showed the highest bleeding rates. Both CABG and valve procedures showed significant increases in bleeding for patients with P2Y12i versus control patients (CABG 9.2% vs 5.7%; valve 17.2% vs 8.9%; both p&lt;0.05). P2Y12i-treated patients with bleeding versus those without bleeding had significant increases in in-hospital mortality (CABG 5.0% vs 2.1%; valve 12.4% vs 4.8%), LOS (CABG 11.7 vs 10.7; valve 13.0 vs 11.6), and ICU LOS (CABG 8.4 vs 5.5; valve 11.2 vs 8.3) (all p&lt;0.05). Similar findings were observed for other procedures. Conclusions: Invasive CV procedures in patients receiving P2Y12i were associated with increased bleeding rates. Patients with increased bleeding had poorer outcomes, including increased in-hospital mortality. Bleeding avoidance in P2Y12i-treated patients requires an adequate discontinuation period prior to invasive procedures. Delaying CV procedures, however, may result in suboptimal outcomes, highlighting the unmet need for a rapid reversal strategy for P2Y12i.
Abstract 13416: Evaluation of Risk Factors for Pacemaker After Tavr Among Patients With a Pre-Existing Right Bundle Branch Block
Authors: Sophie Vitter, George Black, Joshua Kim, John Lisko, Patrick T Gleason, Kendra J Grubb, Adam Greenbaum, Chandan Devireddy, Robert A GUYTON, Bradley G Leshnower, Faisal M Merchant, Mikhael F El-Chami, Stacy Westerman, Anand Shah, Angel R Leon, Michael S Lloyd, Vasilis Babaliaros, Soroosh Kiani
Journal: Circulation (2022)

Background : Pacemaker implantation (PMI) remains a common complication after TAVR. While a pre-existing right bundle branch block (RBBB) is consistently the strongest reported risk factor for PMI, most patients with a RBBB will not require PMI after TAVR. Objective : To identify factors associated with a higher risk of PMI after TAVR among patients with pre-existing RBBB. Methods : We identified all patients at a single institution undergoing first-time TAVR with a balloon-expandable prosthesis without a pre-existing pacemaker or ICD, and pre-existing RBBB (defined as RBBB morphology with QRS &gt;=110ms) from December 2013 to December 2020 (n=219). We evaluated the univariate association for numerous clinical, EKG, imaging, and procedural characteristics with PMI. We included all factors with p=&lt;0.10 in a logistic regression model to assess for independent associations with PMI in the original cohort and 1000 bootstrapped samples. Results : A history of syncope, body mass index, calcium channel blocker use, baseline PR interval, and prosthesis oversizing &gt;16% were associated with PMI on univariate analysis. When included in a logistic regression model, syncope (OR 3.2, 95%CI: 1.1-8.8, p=0.027) and oversizing (OR 3.1, 95% CI: 1.4-6.8, p=0.005) remained independently associated with PMI. These findings were consistent in the bootstrapped samples. Those with both factors (n=4) had a PMI rate of 75% which was higher compared to those with one or neither (43% and 22%, respectively; p&lt;0.001). Conclusion : Among those with pre-existing RBBB, a history of syncope and prosthesis oversizing &gt;16% were independently associated with a higher risk of PMI. These findings warrant external validation.